Page 10 - GHES-2-3

Global Health Economics and
Sustainability
Medical oxygen during COVID-19 pandemic

(Wu et al., 2020; Zhou et al., 2020). Subsequently, the across all states/union territories (UTs), revealing areas
coronavirus swiftly disseminated worldwide, leading to needing improvement in medical oxygen availability.
the World Health Organization’s (WHO) designation of On May 26, 2023, the 76 World Health Assembly
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COVID-19 as a “Public Health Emergency of Concern” (WHA) adopted the Access to Medical Oxygen Resolution
on January 30, 2020 (WHO, 2020a) and as a global to prevent deaths and ensure that no country faces a medical
pandemic on March 11, 2020 (WHO, 2020b). While oxygen shortage as seen during the COVID-19 pandemic
many infected individuals remained asymptomatic (Every Breathe Counts, 2023). The 76 WHA included
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carriers, others experienced a range of symptoms from medical oxygen as a lifesaving essential treatment and added
mild to critical. Fever, cough, and fatigue were common, it to the 8 WHO’s Model List of Essential Medicines for
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while severe cases presented with difficulty breathing Children. Other high-impact actions include developing
and chest pain (WHO, 2022b). A recent investigation by medical oxygen plans, assessing and monitoring oxygen
Lima (2020) identified fever, cough, dyspnea (shortness gaps, raising public awareness about the role of medical
of breath), and myalgia (muscle pain) as prevalent oxygen, and updating national pharmacopeia (WHO,
presenting symptoms of COVID-19. Oxygen therapy, 2023). A new Global Oxygen Alliance (GO2AL) has been
crucial for numerous medical conditions, became a vital launched by global health partners (including WHO,
lifeline for a significant portion of COVID-19 patients, United States Agency for International Development
particularly those with severe infections in India. In the [USAID], United Nations Office for Project Services
initial days of the COVID-19 pandemic, approximately [UNOPS], United Nations International Children’s
15% of COVID-19 patients with severe infection required Emergency Fund [UNICEF], World Bank, Global Fund,
oxygen, and 5% required intensive care (WHO, 2022a). Clinton Health Access Initiative [CHAI], Bill & Melinda
Severe pneumonia due to COVID-19 infection resulted Gates Foundation, Access to Medicine Foundation,
in a surge in oxygen demand globally. According to the Program for Appropriate Technology in Health, Save the
WHO, over 0.5 million patients in low- to middle-income Children, and Every Breath Counts [coalition]) to continue
countries (LMICs) required daily oxygen treatment the vital task of the Access to COVID-19 Tools Accelerator
during the pandemic (WHO, 2021a). (ACT-A) Oxygen Emergency Taskforce, which raised
Recognizing this critical need, the WHO is calling for more than US$1 billion for boosting the accessibility of
a global effort to improve oxygen availability, accessibility, medical oxygen. These efforts include financing to expand
and affordability across the globe (WHO, 2021b). COVID- production, lower the medical oxygen price, and provide
19 exposed a global shortage of easily accessible and technical support to governments (Unitaid, 2023).
affordable medical oxygen, especially in LMICs. Even With this background, this narrative review aims to
before the pandemic, LMICs struggled with patchy oxygen summarize the actions taken by the Government of India
supplies, with approximately one-third (31%) of health- (GoI) to address the medical oxygen need during the
care facilities in sub-Saharan Africa facing interruptions deadly COVID-19 waves in India and prepare for future
and another quarter (25%) having no available oxygen emergencies. In addition, this review summarizes the
at all (Belle et al., 2010). In addition, most seriously ill challenges faced and the success achieved in addressing the
COVID-19 patients admitted to health facilities require oxygen shortage during the COVID-19 pandemic.
mechanical ventilation (Grasselli et al., 2020; WHO,
2022c). The pandemic drastically worsened this situation, 2. Methods
driving oxygen demand up to 200 times normal levels in 2.1. Research question
affected regions such as South America, Africa, and Asia What are the steps or actions taken by the GoI to combat
(WION, 2021).
the shortage of medical oxygen in India during the
COVID-19 highlighted the critical need for properly COVID-19 pandemic, and what lessons can be drawn
equipped treatment centers, including a reliable oxygen from the available literature?
supply, pulse oximeters, and functional oxygen systems
(WHO, 2022a). Recognizing this global challenge, the 2.2. Search strategy
WHO and other organizations are ramping up their efforts Search terms were combined using Boolean operators,
to provide technical support, especially in LMICs. In India, and a search strategy was constructed by AA, KS, and
the pandemic served as a wake-up call for assessing and AV through brainstorming and a preliminary literature
addressing gaps in medical oxygen infrastructure. The search. A literature search was conducted by KS and AA
Ministry of Health and Family Welfare of India conducted on January 31, 2023, covering the date range from January
a comprehensive assessment of public health facilities 2020 to January 31, 2023. This search was further verified

Volume 2 Issue 3 (2024) 2 https://doi.org/10.36922/ghes.2023